Provider Demographics
NPI:1548046170
Name:BIRDSELL, CAITLIN
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BIRDSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2298 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:NE
Mailing Address - Zip Code:68838-1616
Mailing Address - Country:US
Mailing Address - Phone:308-754-8332
Mailing Address - Fax:
Practice Address - Street 1:2298 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:NE
Practice Address - Zip Code:68838-1616
Practice Address - Country:US
Practice Address - Phone:308-754-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health